18 - Discontinuing pacemakers, ventricular assist devices, and implanted cardioverter-defibrillators in end-of-life care

Summary

Disabling a device is not physician-assisted suicide. If a practitioner is uncertain about the mental health of a patient, it is reasonable to consult with a psychiatrist or psychologist. The rationale for disabling the device are based on a fundamental notion of patient autonomy, informed by patient awareness and acceptance of the consequences of the choices made. This chapter presents a case study of a 59-year-old diagnosed with idiopathic ventricular tachycardia and who requested that his ICD be turned off. Each of the three types of currently used cardiac devices pacemakers, implantable cardioverter defibrillator (ICDs), and ventricular assist devices (VADs), has different functions and a different mix of harms and benefits. They represent forms of cardiac-supportive therapies that patients may legitimately forgo or discontinue as part of end-of-life decision-making. Discontinuing cardiac device therapy should be accompanied by thoughtful discussion, discernment of patient goals, and plans for appropriate palliative care.